PSYCHEDELIC PRESENTATION
Transcript: Psychedelics in Psychiatry: A Paradigm Shift by TYLER COWDRY ARNP, COE OBJECTIVES OBJECTIVES Understand what psychedelics are and which compounds are being focused on for mental health Develop an understanding of the history, pharmacodynamics, and research regarding these compounds Discover what psychedelic-assisted therapy is and why preparation, proper facilitation, and integration is pivotal for effective treatment Know the current laws and emerging legislation governing the use of psychedelics nationally and locally and what implications this has for mental health providers OVERVIEW CATALYSTS, NOT CURES Rapid and Sustained Symptom Relief: Clinical trials show that psychedelic substances can lead to significant reductions in several psychiological symptoms after just one to three sessions, often with lasting effects for months. Enhanced Emotional Processing and Neuroplasticity: These compounds support deeper emotional insight and trauma resolution, possibly by increasing neural flexibility and reducing avoidance patterns related to distressing memories. Catalysts for Therapeutic Breakthroughs: When combined with psychotherapy, psychedelics help patients access and reprocess deeply held emotional material, often accelerating progress that would take years in traditional therapy alone PSILOCYBIN (classic) & MDMA (empathogen) COMP0UNDS PSILOCYBIN PSILOCYBIN (CLASSIC) • 5HT hallucinogenic (LSD, DMT) HISTORY Single-Dose Psilocybin Treatment for Major Depressive Disorder A Randomized Clinical Trial (JAMA, 2023) Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up (Journal of Psychopharmacology, 2022) Mayan and Aztec cultures of Mesoamerica. Teonanácatl ("god" + "fungus") Catholic church suppressed its use after the Spanish exploration Siberian cultures and Santa Claus María Sabina and R. Gordon Wasson Albert Hofman and Sandoz pharmaceuticals 1966 US passed laws prohibiting the production, trade or ingestion of hallucinogenic drugs. 1970 Federal Comprehensive Drug Abuse Prevention and Control Act making psilocybin illegal for research purposes and Schedule I status. PHARMACOLOGY Psilocybin vs. Psilocin (prodrug using CYP2D6, CYP3A4) Psilocin similar to 5HT with affinity to 1A, 2A, (and 2C/1B) 5HT-2A/1A agonism is responsible for the psychedelic experience, upward and lateral growth of apical pyramidal neurons + thickening of dendritic spines, Pyramidal neurons = “projection neurons” Accelerates activation of AMPA/NMDA receptors = increase in BDNF Induces transient disintegration of the Default Mode Network (DMN) — implicated in self-referential thought, rumination, and rigid cognitive patterns. Bottom-up regulation with a broader approach in regard to peripheral vs. interoception sensory input (thalamic gating) RESEARCH Drug-drug Interactions Between Psychiatric Medications and MDMA or Psilocybin: A Systematic Review (Psychopharmacology Berl, 2023) RESEARCH CONT. Therapeutic Effect of Psilocybin in Addiction: A Systematic Review (Frontiers in Psychiatry 2023) Acute Effects of Psilocybin After Escitalopram or Placebo Pretreatment in a Randomized, Double-Blind, Placebo-Controlled, Crossover Study in Healthy Subjects (Clinical Pharmacology & Therapeutics, 2021) ONGOING RESEARCH OCD - Yale University & Brown University trials underway Anorexia Nervosa - University of California, San Francisco (UCSF), Johns Hopkins University, COMPASS Pathways: A phase 2 clinical trial is underway OUD - University of Wisconsin–Madison Clinical Trials, Johns Hopkins University Study, Imperial College London Trial OREGON Natural Medicine Health Act Drug-drug Interactions Between Psychiatric Medications and MDMA or Psilocybin: A Systematic Review (Psychopharmacology (Berl) 2022) PSILOCYBIN SESSION Psilocybin Based Therapy for Cancer Related Distress, a Systematic Review and Meta Analysis (BAHI Camile, 2018) Trial of Psilocybin versus Escitalopram for Depression. (New England Journal of Medicine 2021) COLORADO MEASURE 109 PROPOSITION 122 Oregon's Psilocybin Services Act WASHINGTON LEGISLATION • 2022 Legislation: The Washington State Legislature directed the Health Care Authority (HCA) to establish a work group. • 2023 Legislation: In May 2023, Governor Jay Inslee signed Senate Bill 5263 into law, mandating University of Washington School of Medicine to facilitate study for clinicians effected by the COVID pandemic • 2024 Ballot Measure: SB 5201, led by Sen. Jesse Salomon which would allow adults 21+ to access certain “psychedelic substances” in a regulated context • Local Decriminalization Efforts: Tacoma, Seattle, Olympia, and Port Townsend Duration: 4-6 hours (factors: d2d, food intake, metabolization) Onset: 30 - 45 minutes "ego dissolution/oceanic boundlessness" = anxiety Peak effect: 1.5 – 2 hours 2 separate sessions with 2 preparation and integration therapy sessions before and after Dose: 25-50 mg of psilocin (this is typically 2.5-5 g) of dried mushrooms (this is MDMA